Meningomyelocele
Author: Pediatric Oncall
Question.
A 2 month old girl born of non consanguineous marriage presented with hydrocephalus and meningomyelocele diagnosed since birth and excessive crying for 4-5 days. The child had 2 episodes of seizures in last 15 days. On examination, she had wide bulging anterior fontanelle with sun-setting sign and decerebrate posturing with lower lumbosacral meningomyelocele, spastic paraparesis and absent lower limb refluxes.
Answers of this discussion
Author :- emad on 15 March 2014.
Answer :- Difficult to say , but the baby still to be shunted , to avoid more complications , and avoid very big head size Later on . For next pregnancy mother should be in folic acid plus very close up follow up . I advice also to screen Her for TORCH .

Author :- nashwa awad on 16 March 2014.
Answer :- Current intervention is shunt operation and cover meningomyelocel For mother advice to take folic acid 400 mg, day before conception of next pregnancy

Author :- Jed J. Jacobson on 16 March 2014.
Answer :- The decision to intervene must be made with informed consent of the parents, after neurological, neurosurgical and ethical consultations.

Author :- zainul Gagan on 17 March 2014.
Answer :- looking at the history, child is having neural tube defect resulting in Arnold Chiari malformation _?_?. this child has got poor prognosis as surgical management of meningomyelocele is not going to improve the tone of the child. This child require team based approach for management. Regarding next preganancy, folic acid supplementation to mother atleast 14 days prior to conception, with antenatal anomaly scan at 20 weeks is must.

Author :- Rihi Here Wila on 17 March 2014.
Answer :- I think this is the severe form of meningomielocele no need any intervention. For next pregnancy, the mother should routinely control and take folic acid everyday.

Author :- Rosa Maria Delgado-Ayala on 17 March 2014.
Answer :- Check CSF for meningitis {ventricular tap} and treat accordingly if present. Needs VP shunt for hydrocephaly and to correct increased intracranial pressure. Mother needs preventive therapy with daily folic acid during next pregnancy

Author :- koutha rama on 17 March 2014.
Answer :- There is no point in doing surgery in this case. This should have been diagnosed antenatally at 16 weeks or even earlier. If possible.to look into folate pathway genes for the prenatal diagnosis of next pregnancy and also a karyotype on this child The couple`s homocysteine should be checked and give preconceptional folate, B12 and zinc atleast 3 months prior to pregnancy

Author :- ritesh SRIVASTAVA on 18 March 2014.
Answer :- the infant should be ,first treated for CNSinfection and then early surgery. periconceptional Folic Acid must be given to mother in next pregnancy

Author :- Subhasish on 19 March 2014.
Answer :- parents should be counselled and their opinion respected before taking any decision, peri-conceptional folic acid.

Author :- neelesh kumar on 24 March 2014.
Answer :- vp shunt, surgical management of meningomyelocele, folic acid to be started before conception in next pregnancy

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